Over the last few weeks, we’ve had many conversations with clients about changes to the general ledger, payroll, and statistics data they’re tracking during COVID-19.

Data collection and tracking are critical during a crisis to inform decision-making. And since the budget went out the window when the first COVID-19 patients entered your facility — or perhaps before then if you cancelled elective procedures — keeping that information separate will be important once budgeting “normalcy” returns.

General Ledger

From a general ledger perspective, most clients are adding a new department to their general ledger, one within each hospital or entity. They’re using that new department or cost center to track COVID-19-specific expenditures for supply acquisition costs, capital expenditures, and, in some cases, labor. Some clients have also created new account numbers for labor and supply costs related to COVID-19. It’s important to have defined usage rules for these additions. You may need to defend those expenses in order to get reimbursement through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, as well as through the Federal Emergency Management Agency (FEMA) or other grant applications that you may want to pursue.

Some clients are also using the activities feature in their general ledger to track COVID-19 types of expenses at the department level. From a data structure perspective, the majority of our clients do not bring that level of activity into Axiom. If you’re interested in this approach for reporting, however, please contact us and we can assist with the setup.


While labor cost is a huge part of the COVID-19 care process, the focus is more on the employees who are not working. Organizations are tracking furloughed employees, those who have depleted their PTO banks, and even employees who are performing COVID-19 activities that are not part of their normal job responsibilities. Many clients are adding new pay types to track and segregate those payroll expenditures from regular pay, overtime, and non-productive\PTO time.

Employees who are performing COVID-19 activities that are not part of their normal job responsibilities have included finance team members helping fit masks for clinical staff, assisting with traffic control at testing sites, and helping manage services in other areas where organizations need additional people.

Many clients are also creating labor pools of RNs and technical staff who historically worked in clinics or urgent care clinics and are now needed in the hospitals. These labor pools are created in advance so that if a surge does occur, additional resources can be deployed quickly.


The sky is the limit in terms of the types of metrics you could be tracking right now and, currently, any data is good data because there are no definitive rules. Some metrics organizations are tracking include the number of COVID-19 tests administered, positive results of tests, ED visits related to COVID-19, admissions, and deaths.

Telehealth visits certainly have become an important new statistic. We expect that in addition to office visits, telehealth visits and the work RVUs related to those visits will become new primary statistics in performance reporting and budgeting tools, especially in physician clinics.


Many clients collect information hourly or daily. I recently spoke with a client who is bringing their data into the decision support database weekly, but then breaking that information down from a daily perspective. March really was the first month many clients had a significant impact related to COVID-19, so they’re also now summarizing those statistics as part of their monthly GL close process.

Quantifying the impact

Have you quantified the number of surgeries cancelled and the potential lost revenue related to that? How about the number of office visits and procedures cancelled and the corresponding lost revenue? We recommend that you focus on the departments that were impacted by eliminating or cancelling elective surgeries or deferring procedures.

You’ll find several uses for this information. One is helping to quantify the financial impact of lost business for your board, executive team, and other stakeholders who need that information. Second is forecasting for the post-COVID-19 state. Finally, a year from now you’ll be planning your 2022 budget and may need to identify what to add back and how to quantify that. You’ll need these statistics to supplement your regular budget information.

It’s better to capture that information now than to have to go back later to do it.